Provider Demographics
NPI:1366641854
Name:MILLER, MARY LOUISE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:LOUISE
Last Name:MILLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 6TH AVE,
Mailing Address - Street 2:P.O. BOX 648
Mailing Address - City:OURAY
Mailing Address - State:CO
Mailing Address - Zip Code:81427
Mailing Address - Country:US
Mailing Address - Phone:970-325-4800
Mailing Address - Fax:970-325-4800
Practice Address - Street 1:309 6TH AVE,
Practice Address - Street 2:
Practice Address - City:OURAY
Practice Address - State:CO
Practice Address - Zip Code:81427
Practice Address - Country:US
Practice Address - Phone:970-325-4800
Practice Address - Fax:970-325-4800
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7159122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist